Table.

Description of proposed comprehensive ototoxicity monitoring program for Department of Veterans Affairs (COMP-VA) clinical objectives 1–4. Table includes stakeholders in program (who), description of objective (what), implementation time (when), interpretation (how), and relevant citations (evidence base).

Objective	Who: Stakeholder	What: Description of Clinical Objective	When: Timing & Patient Status	How: Basis for Interpretation	Evidence Base: Relevant Citation(s)
1	Patient, audiologist, oncologist	Pretreatment risk assessment: Predict speech frequency shift	Pretreatment counseling & planning	Baseline behavioral audiogram (≤8 kHz) & prescribed cisplatin dose	Dille et al., 2012 [1]; Dille et al., 2012 [39]
2	Audiologist	Screening for outer hair cell dysfunction: Detect early changes in cochlear function	Any monitoring appointment	Larger change in DPOAE level than reference limits	McMillan et al., 2013 [40]; McMillan et al. [under review]
3	Audiologist, oncologist	Screening for early hearing changes (behavioral): Detect shift in SRO	Any monitoring appointment for responsive/reliable patient	Audiologist or patient-administered identification of ASHA-significant thresholds changes	Fausti et al., 1999 [19]; Konrad-Martin et al., 2010 [5]
	Audiologist, oncologist	Screening for early hearing changes (nonbehavioral DPOAEs): Estimate shift in SRO	Any monitoring appointment for patient unable to take behavioral hearing test	Baseline behavioral audiogram (SRO), administered cisplatin dose, & DPOAE I/O or DPOAE fine step	Dille et al., 2010 [2]; Reavis et al., 2011 [23]; McMillan et al., 2013 [40]
4	Patient, audiologist, oncologist	Screen failure follow-up testing (behavioral): Detect speech frequency shift	Upon screen fail for responsive/reliable patient	Behavioral audiogram (≤8 kHz)
	Patient, audiologist, oncologist	Screen failure follow-up testing (nonbehavioral DPOAEs): Estimate speech frequency shift	Upon screen fail for patient unable to take behavioral hearing test	DPOAE model of behavioral audiogram (≤8 kHz)

ASHA = American Speech-Language-Hearing Association, DPOAE = distortion-product otoacoustic emission, I/O = input-output, SRO = sensitive range for ototoxicity.